Wiki.diagnostic fetal assessment tests 2011

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  • Several sites are utilized in aspiration. Can be done earlier than anmio
  • Triple screen: maternal serum alpha fetoprotein (MSAFP), beta hCG, uncongigated estriol Quad Screen: above plus pregnancy associated plasma A protein Need to be aware of maternal weight, gestational age, multiple gestation, race and diabetes – all these can skew results
  • Many studies, none to find side effects to fetus
  • Done with U/S
  • For ABO incompatibilities or hydrops, can tell amt of bilirubin in amniotic fluid to see if fetus needs transfusion
  • Isoimmunization(mom antibodies attack fetal RBC), parvo virus (slows production of RBC), fetal maternal hemorrhage
  • Graph is little blurry but shows how much blood to transfuse.
  • Maternal symptoms: difficulty breathing, uterine contractions
  • Magnetic resonance imaging Able to separate maternal and fetal tissue, clearer image Claustrophobia, size of abd and fitting in chamber
  • Due to organ formation
  • Watch language with pt – tazer, buzzer, zapper VAS programmed for this time, push button till stops Decels common Do not use if fetus compromised or has heart issues
  • Wiki.diagnostic fetal assessment tests 2011

    1. 1. Diagnostic Fetal Assessment tests Sandy Warner RNC-OB, MSN August 3, 2011 Inpatient Review Class
    2. 2. Prenatal Assessments and screening Chorionic Villous sampling:  10-12 wk using U/S to aspirate trophoblastic tissue  Can be done either transabdominally or transvaginally  Detects chromosome abnormality  Risks: miscarriage, bleeding, infection & PROM
    3. 3. Prenatal Assessments and screening cont. Triple or Quad Screen  Blood drawn between 15-20 wks  Can detect Down’s syndrome, other chromosomal abnormalities and neural tube defects  Values of blood tests added together to determine risk  Screening tool – further testing needed for definitive diagnosis
    4. 4. Ultrasound Developed in WWII with submarines Diagnostic use since 1950s Definition: transmission of sound waves to investigate an object  (Kline-Fath & Bitters, 2007)
    5. 5. Placental grading Grade 0 – smooth, dense w/o echogenic areas Grade 1 – undulations present, some echogenic areas Grade 2 – deeper and > indentations, more echogenic areas Grade 3 – dense echogenic areas w/ indentations, areas of calcification
    6. 6. Amniocentesis Trans-abdominal needle aspiration of 10-20 ml of amniotic fluid for lab analysis Done under ultrasound Requires sterile technique and time out
    7. 7. Amniocentesis Indications:  Genetic  R/O infection  Fetal lung maturity  Assess for bilirubin with hemolytic incompatibility
    8. 8. Amniocentesis Timing:  Early – performed between 11-14 wks  Significantly higher pregnancy loss  Post procedure fluid loss  2nd trimester – performed between 15-20 wks  Usually for genetic screening  3rd trimester  Usually for fetal lung maturity  (Gilbert, 4th edition, pg 93)
    9. 9. Cordocentesis /Fetal Blood Transfusion Blood Transfusion for anemia  How much blood is given?  Graph is used correlating the hematocrit of donor blood to the hematocrit of the fetus to determine donor blood volume to be given
    10. 10. Cordocentesis /Fetal Blood Transfusion
    11. 11. Amnioreduction Reduces amount of amniotic fluid around fetus Procedure like amniocentesis only with tubing to suction canister or stopcock Done to relieve maternal symptoms or with twin to twin transfusion syndrome
    12. 12. Amnioreduction
    13. 13. Fetal MRI Superior soft tissue contrast test Does not use radiation Used for fetal brain, spinal deformities, lesions, masses  Also can assess placental and cord malformations Also used to measure lung volume  Research still continuing for PPROM pts  (Kline-Fath & Bitters, 2007)
    14. 14. Fetal MRI Con’t Not recommended in first trimester (no documented studies on harm from heat or sound, but not recommended) Not used routinely, only after U/S not able to detect Contrast dye not recommended Informed consent  (Kline-Fath & Bitters, 2007)
    15. 15. Fetal Echocardiogram Timing: between 18-22 weeks Indications:  Family history congenital heart defects  Maternal diabetes  Drug exposure  Teratogenic exposure  Chromosomal abnormalities  Non-immune hydrops  Maternal PKU  Fetal arrhythmias  Queenan, Hobbins & Spong (4th edition, 2007)
    16. 16. Vibroaccoustic Stimulation (VAS) Artificial acoustic stimulation Done after 25 wks gestation when fetus can hear After 10 minutes of baseline and no accelerations, place the artificial larynx on the maternal abdomen over the fetal head
    17. 17. Vibroaccoustic Stimulation Provide 5-10 sec stimulation near fetal head, wait one minute If no acceleration repeat cycle for a total of three times if non-reactive after 40 minutes, proceed with further evaluation
    18. 18. Vibroaccoustic Stimulation Fetuses 28 weeks or greater respond to VAS with a consistent increase in heart rate. Observed changes are greater as term is approached.
    19. 19. Vibroaccoustic Stimulation(VAS)
    20. 20. References Gilbert, E. S., (2011) 5th edition Manual of High Risk Pregnancy and Delivery. Kline-Fath, B. & Bitters, C. (2007) “Prenatal Imaging” Newborn and Infant Nursing Reviews, Vol.7, No. 4. Mattson, S. & Smith, J.E., (2011) 4th edition Core Curriculum for Maternal-Newborn Nursing. Queenan, J.T., Hobbins, J. C., & Spong, C. Y. (2005) 4th edition, Protocols for High-Risk Pregnancies

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